340B Drug Pricing Program Database
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HV00812B Mary Hitchcock Memorial Hospital dba Ryan White Program (Active)
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Main Details
Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Bedford Clinic, Ryan White Part C
Type
Ryan White Part C
340B ID
HV00812B
Grant Number
H76HA31654
Additional Details
Current Program Status
Active
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/19/2016
Last Recertification Date
2/14/2025
Time Period the Assistance was Received
4/1/2022 - 3/31/2025
Contacts
Authorizing Official
Dartmouth Health
Keith B Thomasset, Chief Pharmacy Officer
(603) 656-0966
Primary Contact
Dartmouth-Hitchcock
Kristin A Chupka, Director - Pharmacy System 340B Program
(603) 656-0945
Addresses
Street Address
5 Washington Place
Bedford, NH 03110
Billing Address
Mary Hitchcock Memorial Hospital
One Medical Center Drive
Lebanon, NH 03756-0001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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